Diabetic Ketoacidosis

General Principles


DKA, a potentially fatal complication of diabetes, occurs in up to 5% of patients with T1DM annually and can occur in insulin-deficient patients with T2DM. It occurs less often in individuals with pancreatic diabetes due to deficient alpha and beta cell function.


DKA is a catabolic condition that results from severe insulin deficiency, often in association with stress and activation of counterregulatory hormones (e.g., catecholamines, glucagon).

Risk Factors

Precipitating factors for DKA include inadvertent or deliberate interruption of insulin therapy, sepsis, trauma, myocardial infarction (MI), and pregnancy. DKA may be the first presentation of T1DM and, rarely, T2DM. DKA with euglycemia or lower-than-expected glucoses can occur with use of the sodium–glucose cotransporter-2 (SGLT2) inhibitor drugs, atypical antipsychotic agents, and some chemotherapy agents.


DKA can be prevented in many cases, and its occurrence often suggests a breakdown in patient education and communication. Therefore, diabetes education should be reinforced at every opportunity, with special emphasis on (1) self-management skills during sick days; (2) the body’s need for more, rather than less, insulin during illness; (3) testing of blood or urine for ketones; and (4) procedures for obtaining timely and preventive medical advice.

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